# of ultrasounds--question

"annafine" wrote in message
om...
I'm 35 weeks 4 days...today. At my appointment 2 weeks ago, the OB
said the Baby was in the breech position because of where she found
the heart beat at.

I'm a little suspicious of a caregiver who can't determine with reasonable
certainty by palpation whether the baby is breech or not. The difference
between the way the head and bum feels to an experienced practitioner is
pretty dramatic!

She mentioned something about if the baby is still
breech at my next appointment that we may have to plan a c-section.

My appointment is today, so we'll see if she believes the baby to
still be breech or not.

If she thinks the baby is still breech, I'd like to have it confirmed
by u/s BEFORE planning a c-section.

Well, the first question is WHY, oh WHY, would your doctor recommend going
straight to C-section at 37 weeks without at least TRYING an external
version first? Sometimes, version isn't possible, and a ultrasound *is*
needed to determine whether the version is possible and then to see what's
happening when it's being done, but I'd FAR and AWAY choose an attempted
version over a c-section, given the choice.

I'd also be inclined, even if the baby *didn't* turn and I couldn't get a
version to work, to wait for labor to start or at least later than 37 weeks
to have the section done. Why? Because babies have been known to turn even
*after* 37 weeks, both from breech to vertex and from vertex to breech
(which is a real pain!). I'd want to give the baby absolutely as long as was
reasonably possible to get itself the right way 'round before submitting to
the knife.
--
Be well, Barbara
(Julian [6], Aurora [4], and Vernon's [18mo] mom)
See us at http://photos.yahoo.com/guavaln

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annafine wrote:

Or unlucky! Repeated medical studies have shown that there is NO
benefit to routine ultrasounds. Why do something this unnecessary?

Larry


Would it be necessary to have another u/s if the doctor *believes* the
baby to be in the breech position at 35 weeks 4 days?


Personally, I'd wait a bit longer. Optimal time
for a version (in most situations) is usually in the 37th
week. At 35 weeks, there's still a decent chance the baby
will turn on his or her own. I'd keep up with the
exercises and do an u/s as late as possible, leaving time
for a version before 38 weeks if the u/s shows the baby
is still breech.

Best wishes,
Ericka

annafine writes:
: Or unlucky! Repeated medical studies have shown that there is NO
: benefit to routine ultrasounds. Why do something this unnecessary?
:
: Larry

: Would it be necessary to have another u/s if the doctor *believes* the
: baby to be in the breech position at 35 weeks 4 days?

: Anna

Well, if you did, that certainly would not be considered *routine*.

I think you would like some fairly definitive method of determining the
position of the baby. Depending on how good (or not) his skills of
determining baby's position by palpitation, he might want an ultrasound.

Not the real question is this a hypothetical or a real case? If the
latter, then at least the mother would want to do something to turn
the baby.

Larry

Circe wrote:

"annafine" wrote in message
om...

I'm 35 weeks 4 days...today. At my appointment 2 weeks ago, the OB
said the Baby was in the breech position because of where she found
the heart beat at.


I'm a little suspicious of a caregiver who can't determine with reasonable
certainty by palpation whether the baby is breech or not. The difference
between the way the head and bum feels to an experienced practitioner is
pretty dramatic!


Usually! ;-) Genevieve was into fooling people. I
swear every midwife in the practice was poking at me and they
disagreed on which end was up (hence the u/s to confirm).
With the boys, I could tell myself. With Genevieve, I had
a hard time too.


Best wishes,

Ericka

"Ericka Kammerer" wrote in message
...
Circe wrote:
"annafine" wrote in message
om...
I'm 35 weeks 4 days...today. At my appointment 2 weeks ago, the OB
said the Baby was in the breech position because of where she found
the heart beat at.

I'm a little suspicious of a caregiver who can't determine with
reasonable
certainty by palpation whether the baby is breech or not. The difference
between the way the head and bum feels to an experienced practitioner is
pretty dramatic!

Usually! ;-) Genevieve was into fooling people. I
swear every midwife in the practice was poking at me and they
disagreed on which end was up (hence the u/s to confirm).
With the boys, I could tell myself. With Genevieve, I had
a hard time too.

Yeah, I suppose there are always the ones that fool you. Still, I found it
surprising that the doctor seemed to be judging the baby's position based
almost entirely on where she found the heartbeat. I'd think she'd also
palpate to confirm and then say she wasn't *sure* so an ultrasound might be
in order. Maybe she did do that and that's just not in the OP's post,
though.
--
Be well, Barbara
(Julian [6], Aurora [4], and Vernon's [18mo] mom)
See us at http://photos.yahoo.com/guavaln

This week's special at the English Language Butcher Shop:
"No parking passed this sign" -- hotel parking lot sign

All opinions expressed in this post are well-reasoned and insightful.
Needless to say, they are not those of my Internet Service Provider, its
other subscribers or lackeys. Anyone who says otherwise is itchin' for a
fight. -- with apologies to Michael Feldman

"Nan" wrote in message
...
Ime, the doctor will do an u/s before performing a c-section.
However, you may still choose to hold off, and ask that labor begin
naturally. Then you can request that the version be done at that
time.
If I'd known 3.6 years ago, I wouldn't have had a c-section, but my
water broke at 37 weeks before a version could be attempted, and the
doctor just decided a c-section was necessary.
In hindsight, I would have insisted on an attempted version before
surgery was performed.

FWIW, I'm not sure a version can be performed once you are *in* labor. The
hardening of the uterus would tend, I would think, to prevent the
practitioner from being able to manipulate the baby's position sufficiently
to turn him/her. I've never had a version, but it seems to me that the
uterus has to be pretty pliable for it to work. A lot of the time, they give
the mother a muscle relaxant prior to trying it. Ericka?
--
Be well, Barbara
(Julian [6], Aurora [4], and Vernon's [18mo] mom)
See us at http://photos.yahoo.com/guavaln

This week's special at the English Language Butcher Shop:
"No parking passed this sign" -- hotel parking lot sign

All opinions expressed in this post are well-reasoned and insightful.
Needless to say, they are not those of my Internet Service Provider, its
other subscribers or lackeys. Anyone who says otherwise is itchin' for a
fight. -- with apologies to Michael Feldman

I know that the ng changes its "groupthink" as the membership evolves, but
have all of the wisewomen forgotten about pulsatilla (homeopathic remedy)
and moxibustion (the burning of herbs at acupressure points) to turn breech
babies? External versions are certainly an option, but if I had a breech
even at 40 weeks I'd be trying puls. and if that didn't work I'd find an
acupuncturist who could do the moxibustion. I know moxibustion is proven to
be highly effective in clinical trials, and I think the pulsatilla has some
trialing as well. A good long time every day in a
head-on-arms-butt-in-the-air position is very effective for some women as
well. Since external versions do carry a small risk and are often quite
uncomfortable, it's a good idea to use all the gentle methods first.

I've used pulsatilla to turn malpresented (transverse, since head or tail
doesn't really matter) puppies, and it really does work even in labor.

--
Joanna
Meriwether, 6
Honour, 4
EDD 5/4/04

"Joanna Kimball" thenospacekimballsatintergatedotcom wrote in message
...
I know that the ng changes its "groupthink" as the membership evolves, but
have all of the wisewomen forgotten about pulsatilla (homeopathic remedy)
and moxibustion (the burning of herbs at acupressure points) to turn
breech
babies? External versions are certainly an option, but if I had a breech
even at 40 weeks I'd be trying puls. and if that didn't work I'd find an
acupuncturist who could do the moxibustion. I know moxibustion is proven
to
be highly effective in clinical trials, and I think the pulsatilla has
some
trialing as well. A good long time every day in a
head-on-arms-butt-in-the-air position is very effective for some women as
well. Since external versions do carry a small risk and are often quite
uncomfortable, it's a good idea to use all the gentle methods first.

My understanding is that moxibustion seems to work well with repeated
treatments over a series of several weeks because it appears to stimulate
fetal movement. This means, however, that it needs to be started a bit
earlier than 35-36 weeks to be successful. The study I found with the best
actual statistics (abstract quoted below) seemed to suggest that treatments
between 33 and 35 weeks were optimal.

So, it's not that moxibustion didn't occur to me at all, but that I thought
the OP was probably past the point at which it would be most likely to work.
And, of course, depending on where you're located, it might be hard to find
someone who would know how to do it!

Moxibustion for correction of breech presentation: a randomized controlled
trial.

Cardini F, Weixin H.



CONTEXT: Traditional Chinese medicine uses moxibustion (burning herbs to
stimulate acupuncture points) of acupoint BL 67 (Zhiyin, located beside the
outer corner of the fifth toenail), to promote version of fetuses in breech
presentation. Its effect may be through increasing fetal activity. However,
no randomized controlled trial has evaluated the efficacy of this therapy.
OBJECTIVE: To evaluate the efficacy and safety of moxibustion on acupoint BL
67 to increase fetal activity and correct breech presentation. DESIGN:
Randomized, controlled, open clinical trial. SETTING: Outpatient departments
of the Women's Hospital of Jiangxi Province, Nanchang, and Jiujiang Women's
and Children's Hospital in the People's Republic of China. PATIENTS:
Primigravidas in the 33rd week of gestation with normal pregnancy and an
ultrasound diagnosis of breech presentation. INTERVENTIONS: The 130 subjects
randomized to the intervention group received stimulation of acupoint BL 67
by moxa (Japanese term for Artemisia vulgaris) rolls for 7 days, with
treatment for an additional 7 days if the fetus persisted in the breech
presentation. The 130 subjects randomized to the control group received
routine care but no interventions for breech presentation. Subjects with
persistent breech presentation after 2 weeks of treatment could undergo
external cephalic version anytime between 35 weeks' gestation and delivery.
MAIN OUTCOME MEASURES: Fetal movements counted by the mother during 1 hour
each day for 1 week; number of cephalic presentations during the 35th week
and at delivery. RESULTS: The intervention group experienced a mean of 48.45
fetal movements vs 35.35 in the control group (P.001; 95% confidence
interval [CI] for difference, 10.56-15.60). During the 35th week of
gestation, 98 (75.4%) of 130 fetuses in the intervention group were cephalic
vs 62 (47.7%) of 130 fetuses in the control group (P.001; relative risk
[RR], 1.58; 95% CI, 1.29-1.94). Despite the fact that 24 subjects in the
control group and 1 subject in the intervention group underwent external
cephalic version, 98 (75.4%) of the 130 fetuses in the intervention group
were cephalic at birth vs 81 (62.3%) of the 130 fetuses in the control group
(P = .02; RR, 1.21; 95% CI, 1.02-1.43). CONCLUSION: Among primigravidas with
breech presentation during the 33rd week of gestation, moxibustion for 1 to
2 weeks increased fetal activity during the treatment period and cephalic
presentation after the treatment period and at delivery."
--
Be well, Barbara
(Julian [6], Aurora [4], and Vernon's [18mo] mom)
See us at http://photos.yahoo.com/guavaln

This week's special at the English Language Butcher Shop:
"No parking passed this sign" -- hotel parking lot sign

All opinions expressed in this post are well-reasoned and insightful.
Needless to say, they are not those of my Internet Service Provider, its
other subscribers or lackeys. Anyone who says otherwise is itchin' for a
fight. -- with apologies to Michael Feldman

Joanna Kimball wrote:

I know that the ng changes its "groupthink" as the membership evolves, but
have all of the wisewomen forgotten about pulsatilla (homeopathic remedy)
and moxibustion (the burning of herbs at acupressure points) to turn breech
babies?


I think both are mentioned at the GentleBirth website.

External versions are certainly an option, but if I had a breech
even at 40 weeks I'd be trying puls. and if that didn't work I'd find an
acupuncturist who could do the moxibustion. I know moxibustion is proven to
be highly effective in clinical trials, and I think the pulsatilla has some
trialing as well. A good long time every day in a
head-on-arms-butt-in-the-air position is very effective for some women as
well. Since external versions do carry a small risk and are often quite
uncomfortable, it's a good idea to use all the gentle methods first.

I've used pulsatilla to turn malpresented (transverse, since head or tail
doesn't really matter) puppies, and it really does work even in labor.


That's a nice theory, but for some it doesn't work in
practice. I could have taken that route with the DEMs I saw
in Michigan, but not with the CNMs I saw here in Virginia.
I had to get that baby turned or it would have been a mandatory
transfer to an OB. If I went into labor with the baby in a
breech position, the midwives couldn't have attended and I
would have risked out of my only legal option for an attended
homebirth in the area. Therefore, I had to get that baby turned.
I tried the gentle methods until my time ran out, and then
opted for a version so that I could retain my option for a
homebirth. If the regulatory situation were different, I
could have pursued some other options, but it wasn't so I
had to cope with the situation I was in.

Best wishes,
Ericka

annafine wrote:
My experiences:

#1: no ultrasounds
#2: no ultrasounds
#3: 37 week u/s to confirm breech position
37 week u/s immediately before and immediately after
the external version used to turn her

Best wishes,
Ericka


I'm 35 weeks 4 days, and have an appointment with my OB today. At my
last appointment, 2 weeks ago, Baby was believed to be breech. OB
said if baby is still breech (today) that we may have to plan for a
c-section delivery.

I'm hoping she'll at least order an u/s to confirm the breech position
before we have to plan for a c-section. I also plan to ask her about
using a version to turn the baby.

Anna

My son turned from breech to vertex at 37 weeks.

At 10 days past his due date he turned from vertex back to breech. I
really wished I had waited to go into labor and had them attempt a
version rather than getting sectioned.

At 30 weeks this current babe is not vertex, if it is still breech when
I go into labor I will get the OB to try and turn it then. I do not want
to go under the knife again!!

Larissa
DD Feb 99
DS Mar 01
EDD early dec-ish 2003